Tag Archives: special needs toilet training

Low Tone and Toilet Training: The 4 Types of Training Readiness

When clients ask me if I think their child is ready to potty train, my answer is usually “Maybe”.  There are numerous factors to consider when assessing toilet training readiness if a child has low muscle tone.

Physical Readiness

After about 18 months, most children can keep a diaper dry for an hour or more.  Their sphincter control increases, and their bladder size does too.  Kids with low tone can take a little longer, but without additional neurological issues, by 24 months many of them will be able to achieve this goal to accomplish daytime urinary continence.  Bowel control is usually later, and nighttime control is later still.  Achievement of the OTHER physical readiness skills are less predictable.  These skills include:

You will notice that children need enough skill, not amazing or even good skills.  They just need enough ability to get the job done.

I need to mention that issues such as constipation can derail the best plans.  Kids with low tone are more likely to have this problem than not.   Read my post Constipation and Toilet Training  for some ideas on how to manage this issue and who can help you.  The best time to manage constipation is before you start training.

Cognitive/Communication/Social Readiness

The trifecta for toilet training readiness in typical children is a child who is at the 16-20 month cognitive/communication/social level.  This child has the ability to follow simple routines and directions, can understand and communicate the need to use the toilet and their basic concerns, and is interested in learning a skill that adults are guiding and praising.  If your child has receptive language issues (difficulty understanding what you are saying0 then read Targeted Toilet Training Strategies to Help The Child With A Receptive Language Delay for some specific strategies.

What about children with global developmental delays?  They absolutely can be toilet trained.  I have worked with children who have no verbal skills and perform tasks like dressing and self-feeding only by being prompted, but they can use the toilet.  Do they always know when to “go”, or do they simply follow a schedule?  Well, to be honest, sometimes they toilet on a schedule for quite a while before they connect the physical impulse with the action by themselves.  But they are dry all day.  The essential abilities are these:  they know what they need to do when they sit on the potty, and they know that they are being praised or rewarded in some other way for that action.  That’s it.  Have faith; children with developmental delays can do this!!

Some children with low tone have no delays in any of these areas, but many have delays in one or more.  The most difficult situation with cognitive/communication or social readiness?  A child who has developed a pattern of defiance or avoidance, and is more committed to resisting parental directions than working together.  Toddlers are notoriously defiant at times, but some will spend all their energy defying any directive, must have everything their way or else, and can even enjoy being dependent.

If this is your child, job #1 is to turn this ship around.  Toilet training will never succeed if it is a battle of wills.  And no adult wants it that way.  Repair this relationship before you train, and both of you will be happier.  Read my posts on the Happiest Toddler on the Block methods for ideas on how to use “Gossiping” Let Your Toddler Hear You Gossiping (About Him!)and  Turn Around Toddler Defiance Using “Feed the Meter” Strategies to build a more cooperative relationship with your child.

Family Readiness

Research suggests to me that the number one indicator for training is when the parents are ready.  Sounds off, right?  But if the family isn’t really ready, it isn’t likely to work.  I worked with a family that had their first 3 children in rural Russia.  Boiling dirty diapers on a wood stove makes you ready ASAP!  Families need the time to train, time to observe voiding/elimination patterns and to identify rewards that work for their child.  They need to be prepared to be calm, not angry, when accidents happen and to avoid harsh punishments when a child’s intentional avoidance creates an accident.  They have to be ready to respond to fears and defiance, and then handle the new independence that could bring a child freedom from diapers but more insistence on control in other areas.  Many of my clients have nannies, and most parents have partners. Every adult that is part of the training process has to be in agreement about how to train.  Even if they are more cheerleader than “chief potty coach”, it is either a team effort or it is going to be a confusing and slower process.  Check out Toilet Training Has It’s (Seen and Unseen) Costs for more information about how the process of training has  demands on you that are not always obvious.

Equipment Readiness

Do you have a stable and comfortable potty seat or toilet insert?  How will your child get on and off safely?  Do you need a bench or a stair-like device?  Grab bars?  Do you have wipes or thick TP? Enough clothing that is easy to manage?  Underwear or pull-ups that also do the job?  One of my clients just texted me that having a mirror in front of her daughter seemed to help her manage her clothing more independently.   A few weeks ago we placed the potty seat against a wall and in the corner of the room so that if she sat down too fast or hit the edge of the seat with her legs while backing up or standing, it wouldn’t tip and scare her.  No rugs or mats around, so she won’t have to deal with uneven or changing surfaces as she gets to the potty.

Really think out the whole experience for safety, simplicity, and focus. You might want to install a child-sized potty in your child’s main bathroom Should You Install a Child-Sized Potty for Your Special Needs Child?.   If you want to learn what your occupational and physical therapists know about these things, ask them Low Tone and Toilet Training: How Can Your Child’s Therapists Help You ?

You can see why parents rarely get a simple answer when they ask me if their child is ready to train.  I will say that since they are asking the question, they may be ready, and that is one of the four types of readiness!

Do you want more details on toilet training readiness?  

The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is available as an e-book on my website, tranquil babies, on Amazon.com,  or at Your Therapy Source ( a terrific site for parents and therapists!).  If you want more guidance to evaluate your child’s toilet training readiness and learn how to prepare them well, this is your book!  It includes readiness checklists and very specific strategies to build readiness.  Think you are ready to jump in and start training?  My book will guide you to choose between the gradual and the “boot camp” approach, and it addresses the most common stumbling blocks children experience on the road to independence.

Read my post The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived! , to learn more about this unique book and see what it can do for you today!

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Low Tone and Toilet Training: The Importance of Dry Runs (Pun Totally Intended)

In my posts about choosing a potty seat, How To Pick The Best Potty Seat For Toilet Training A Child With Low Tone  then picking clothes and learning to wipe, Low Tone and Toilet Training: Teaching Toddlers to Wipe,  planning and preparation for potty use was emphasized.  Kids who are unsteady and struggle with coordinating actions need to have really good skills under pressure to use the toilet successfully.  I am going to give you my best strategy yet for potty success:  dry runs.

It is exactly what it sounds like.  Nobody has to “go”.  It is practice managing the clothes, the toilet paper, and the movement transitions (sit, stand, turn around) of toileting.  Some kids are old enough to understand the concept of pretending, and some may be a little confused.  Even if they are uncertain about it, you should still work on these skills at times when they don’t have to toilet.  You can say explicitly that we are pretending, practicing, or phrase it however you wish.  In my private practice, I use “work clothes” for dressing practice.  Kids change their clothes at the beginning of our session, and then change back into their original outfit at the end of the session.  Once it is our routine, kids don’t complain much.  It doesn’t hurt that the activity I offer right after putting on “work clothes” is one of their favorites, and so is the activity we do after taking them off at the end of our session.  Twice the practice, but also no stress to get out the door to daycare, no fatigue at the end of the day.

Dry runs do not have to be a full dress rehearsal.  You can break it up into just practicing pulling pants down/up, or standing up and sitting down smoothly.   For kids that cannot handle changing routines but aren’t ready to do a full dress rehearsal, perform some of the steps for them at first, rather than leaving them out.  Talk about what you are doing, and try to keep their attention on you as you perform some of the actions.  Children at all levels of skill need to be at least aware of each step.

Each child will have their own specific challenges, but there are some aspects of toileting that can challenge kids with low tone:

  • Where to grasp clothing, how to place fingers for a stable grip, and how far to pull pants down need to be clear.
  • Where to place their feet for a stable stance.  Kids that have poor proprioception won’t automatically place their feet in the right spot, and splints/braces can give them stability but remove even more proprioceptive and tactile input.  They might need a marked spot for foot placement on the floor or on the step stool.
  • If they are standing up to wipe or pee, they may need to hold on to something with one hand.  Be very clear where that spot is and what objects are bad choices to hold onto.
  • Children who also have language, memory, modulation and attention issues may need very specific, very short and very familiar verbal cues.  The same cue that is said  in the same way helps them to stay calm and focused.  Figure out what prompts are understood quickly and use them every time.

Dressing skills in general are important to learn for all children, even kids with global and profound delays.  Independence changes a person’s self-image, and kids with low tone often stay dependent in many skills long after toddlerhood.  Make it clear that you are proud of them and value their emerging abilities.  Children want to please, even the defiant ones, even the kids with cognitive and behavioral issues.  They all want to please adults in their lives.  Even when they don’t seem to, they do.  They also want to be independent and control aspects of their daily lives.

Go have some “dry runs” and see if it moves your child’s toilet training forward this week!

 

Want more assistance than just reading blog posts?  Visit my website tranquil babies and purchase a video or phone session!   You can ask questions, get a review of your set-up and your equipment, and learn new techniques.